** The pt. controls the amount and frequency of the analgesic which is typically delivered through a special infusion device
Children who are physically able to "push a button" (5-6 years old) and who can understand the concept of pusing a button to obtain pain relief can use it
PCA can be controlled by child, family member, or nurse
somewhat controversial for button to be pressed by family member or nurse
pt. safety must be closely monitored
Nurses use PCA to administer analgesics without having to sign for and prepare opioid injections every time one is needed
3 Modes of Drug Administration (used alone or in combination)
Pt.-administered boluses: can only be infused according to the preset amount and lockout interval (time between doses). More frequent attempts at self-administration usually means the pt may need the dose and time to be adjusted for better pain control
Nurse-administered boluses: are typically used to give an initial loading dose to increase blood levels rapidly and to relieve breakthrough pain (pain not relieved with the usual programmed dose)
Continuous basal rate infusion: delivers a constant amount of analgesic and prevents pain from returning during those times, such as sleep, when the pt cannot control the infusion
Continuous pain assessment is essential
Morphine= drug of choice
Fentanyl, hydromorphone, and meperidine (short-term) also used
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